How to “see through” cancer? How can Shanghai improve cancer prevention and control? This manual shares knowledge and experiences.
On December 18, “The Shanghai Cancer Prevention and Control Knowledge Handbook: ‘Seeing Through’ Cancer” was published in Shanghai. The handbook is a condensed source of knowledge from numerous public health experts and renowned doctors, focusing on the significant public health issue of cancer prevention and control while precisely understanding the current health trends.
As one of the major diseases threatening human life and health, cancer’s latest statistics show that the early diagnosis ratio of common malignancies in Shanghai has increased to 40%, and the five-year survival rate for cancer has reached 59%. This marks a 14 percentage point increase over the past decade, surpassing the national average by 15 percentage points, placing Shanghai at the forefront of cancer treatment in China and demonstrating a steady upward trend.
This achievement is attributed to the effective implementation of the “three early” strategy—early detection, early diagnosis, and early treatment. Over the years, Shanghai has increased investment in cancer screening projects and expanded their coverage, enabling more citizens to promptly detect tumors in their early stages. Moreover, by enhancing the diagnostic capabilities and treatment standards of healthcare institutions, the accuracy of early diagnoses is ensured, providing patients with more personalized and precise treatment plans.
The handbook elaborates on topics from how to detect lung cancer, the ‘leading cancer’, to how to eliminate colon cancer, dubbed the ‘dumbest cancer’. It discusses thyroid cancer, which is more prevalent among younger women, and breast cancer, no longer known solely as a ‘killer of beautiful women’. Additionally, it addresses how healthy eating can prevent stomach cancer, the need for middle-aged and elderly men to be vigilant against prostate cancer, and the challenges of early detection for pancreatic cancer, along with the ‘golden combinations’ of screenings for liver cancer. The content also includes strategies for preventing esophageal cancer, categorized as having ‘illness from the mouth’, and cervical cancer, considered ‘easily preventable’.
The handbook encapsulates Shanghai’s successful experiences in cancer prevention and control.
World Health Organization indicates that one-third of cancers are completely preventable, one-third can be cured through early detection, and one-third can have their survival periods prolonged, symptoms alleviated, and quality of life improved with existing medical measures.
“Over the years, Shanghai has continuously strengthened the research and promotion of suitable technologies for cancer screening, regularly conducting screenings for colorectal, cervical, and breast cancers to steadily advance early discovery, diagnosis, and treatment of cancer, thus improving patient survival rates,” stated Shi Yan, Director of the Chronic Non-infectious Diseases Prevention and Control Center in Shanghai.
Regarding colorectal cancer, since 2008, the Shanghai Centers for Disease Control and Prevention has been leading a pilot screening program in Qibao Town of Minhang District, yielding excellent results. In 2011, the community colorectal cancer screening was included as a major public health service project by the Shanghai municipal government. Since 2013, the program has provided free risk assessments and fecal occult blood tests to eligible residents through community health service centers while guiding high-risk individuals to complete colonoscopies. Notably, among the colorectal cancer cases detected, the early stage proportion reached 46%, which is 3.5 times the average level prior to screening. The five-year survival rate for these patients soared to 85%.
Similarly, cervical cancer was once the leading malignant tumor threatening middle-aged women, with high-risk human papillomavirus (HPV) identified as the main carcinogenic factor. Since 1958, Shanghai’s maternal and child health personnel have conducted gynecological examinations for over 300,000 women in factories and neighborhoods, employing Pap smears for cervical cancer screening and offering timely treatment for cervical cancer and precancerous lesions. The incidence rate of cervical cancer dropped from 91.5 per 100,000 in 1958-1960 to 34.3 per 100,000 in 1970-1972. A two-year gynecological examination regimen was implemented in 1974, and by 1990, cervical cancer had fallen from the top to the tenth place among malignant tumors affecting women.
Although the incidence of cervical cancer rebounded after 2000, it remains at a low level. In 2009, a program for free cervical cancer screenings for rural women was launched. Currently, the cervical cancer screening program of Shanghai targets retired and economically disadvantaged women, having screened over 7.33 million people from 2011 to 2020, with coverage exceeding 90%.
Raising awareness and promoting healthy lifestyles are essential for effective cancer prevention and control. Recent data indicates that the health literacy level of Shanghai residents reached 40.46% in 2023, marking a 16-year consecutive increase and setting a historical high, with key health indicators maintaining a leading position comparable to developed nations and regions. In evaluations of the Healthy China initiative, Shanghai has achieved its targets for 16 out of 2030’s indicators ahead of schedule.
The continuous improvement in health literacy is backed by a series of health education and popular science actions. Each year from April 15-21, Shanghai observes Cancer Prevention and Control Awareness Week, which has been promoted nationally since its inception in 1989, focusing on the risk factors of lifestyles and spreading awareness about cancer prevention, screening, diagnosis, treatment, and rehabilitation. Since 2008, the Shanghai municipal government has provided free health knowledge handbooks and practical health tools to all households in the city for 17 consecutive years, guiding residents to practice healthy lifestyles.
The handbook also lists cancer risk factors.
“Among all carcinogenic risk factors, age and genetic factors are difficult to change, but other factors are modifiable,” Shi Yan explained. For instance, behaviors like smoking and drinking alcohol, poor dietary habits, metabolic issues such as diabetes, and environmental factors are intervenable. “We can adjust these through smoking cessation, alcohol limitation, balanced diets, moderate exercise, occupational safety, weight management, vaccinations, and reducing environmental pollution.”
From a policy perspective, health initiatives have been integrated into various strategies. The “Healthy Shanghai Action Plan (2019-2030)” encompasses 18 major special actions, 100 measures, and 177 monitoring and evaluation indicators aimed at enhancing the depth and breadth of health initiatives. With substantial harm from smoking and high cancer risks associated, Shanghai’s smoking control legislation has undergone two revisions since 2010, continually adapting to improve conditions in public venues; also, plans are underway to test nutrient grading labels for beverages starting in 2024 due to the detrimental effects of excessive sugary drink consumption.
Furthermore, Shanghai established the most comprehensive Health Science Popularization Expert Database, covering 38 disciplines with 629 experts, to jointly promote the concept of health literacy.
To leverage the role of medical institutions and professionals as the ‘main front’ and ‘main force’, Shanghai pioneered a health science popularization initiative supported by public budget since 2021, conducting programs for four consecutive years that involve guiding doctors to engage with local communities for health education.
New technologies, including genetic diagnostics supported by artificial intelligence, are also enhancing Shanghai’s cancer prevention and control capabilities. In recent years, genetics has played an increasingly significant role in cancer prevention, early screening, and clinical diagnosis. Research indicates that about 10% of cancers have a hereditary component.
“In cancer prevention, identifying susceptible genes allows for cancer risk assessments. For high-risk individuals, personalized prevention strategies can be developed, guiding lifestyle adjustments to reduce environmental risk factors. During early screening, specific types of cancer can be detected early through circulating tumor DNA (ctDNA) in blood, gene methylation in stool samples, and other biomarkers,” pointed out Shao Minhua from the Fudan University Engineering Research Center for Gene Technology.
Shao also highlighted that with continuous advancements in gene editing technology, gene therapy, and synthetic biology, genetic technologies are becoming more widely and deeply applied in cancer prevention, screening, and treatment, offering more options and hope for cancer patients, thus driving progress in cancer therapies.
In addition to genetic diagnostics, the role of AI is increasingly significant, with more AI technologies being integrated into clinical applications, ushering cancer treatment into a new era of intelligence. Shao emphasized that through deep learning and big data analysis, AI can efficiently process vast amounts of genetic sequencing data and clinical information, identifying complex gene mutation patterns and their association with cancer development, thereby significantly enhancing the accuracy and efficiency of cancer diagnoses and assisting clinicians in creating personalized treatment plans for patients.
Moreover, AI shows tremendous potential in image recognition, pathological analysis, and the development of gene-based drugs, gradually establishing itself as an important auxiliary tool in the field of cancer prevention and control.
